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					  District School Board of Niagara

(Maintenance and Caretaking Employees Local 4156)


                      Group Plan No. 83620/25456
                                      (Division 3)
 Chapter      Group File
Your Group Benefits Booklet

Keep in a safe place
This booklet is a valuable source of information for you and your family. It provides the information you need about
the group benefits available through your employer’s group plan with Sun Life Assurance Company of Canada
(Sun Life), a member of the Sun Life Financial group of companies. Please keep it in a safe place. We also
recommend that you familiarize yourself with this information and refer to it when making a claim for group benefits.


Your Plan Administrator is there to help
Your plan administrator can:
 •     help you enrol in the plan
 •     provide you with the forms you need to claim group benefits
 •     answer any questions you may have


Benefits and claims information at your fingertips
For more information about your group benefits or claims, please call Sun Life's Customer Care Centre toll-free
number at 1-800-361-6212.


We're on the Internet!
Learn more by surfing Sun Life's website. There's information about group benefits, and about Sun Life's products
and services... and a whole lot more! Check us out!
Our address is:
www.sunlife.ca


Respecting Your Privacy
At Sun Life Financial, protecting your privacy is a priority. We maintain a confidential file in our offices containing
personal information about you and your contract(s) with us. Our files are kept for the purpose of providing you with
investment and insurance products or services that will help you meet your lifetime financial objectives. Access to
your personal information is restricted to those employees, representatives and third party service providers who are
responsible for the administration, processing and servicing of your contract(s) with us, our reinsurers or any other
person whom you authorize. In some instances these persons may be located outside Canada, and your personal
information may be subject to the laws of those foreign jurisdictions. You are entitled to consult the information
contained in our file and, if applicable, to have it corrected by sending a written request to us.

To find out about our Privacy Policy, visit our website at www.sunlife.ca, or send a written request by e-mail to
privacyofficer@sunlife.com, or by mail to Privacy Officer, Sun Life Financial, 225 King St. West, Toronto ON M5V
3C5 to request that a copy of our Privacy Brochure be sent to you.


     The statements in this booklet are only a summary of some of the provisions in
     the master policy. If you need further details on the provisions which apply to
     your group benefits you must refer to the master policy (available from your plan
     administrator).




Your Group Benefits Booklet
    A           ba00s

Summary of Insurance

Policy Number 83620-3 - Life and Long Term Disability Insurance

Basic Life Insurance
                                                      Benefit              Maximum
                Class of Members                      Formula               Benefit
    Eligible Maintenance and Caretaking          2x annual earnings        $200,000
    Employees (Local 4156)

Benefit Reduction: reduces to 1x annual earnings at age 65
Termination of Insurance:
The earlier of:
•       the end of the School Year in which you reach your 70th birthday, or
•       the end of the month in which employment terminates, whichever is earlier.

Optional Member Life Insurance
            Class of Members             Benefit Formula        Non            Maximum
                                                              Evidence          Benefit
                                                              Maximum
    Eligible Maintenance and             units of $10,000       $30,000*       $250,000
    Caretaking Employees (Local
    4156)

*Non evidence maximum applies to new hires only.

Termination of Insurance: 65th birthday, or retirement if earlier

Optional Spousal Life Insurance
             Class of Dependants               Benefit Formula        Maximum Benefit
    Spouse                                     units of $10,000            $250,000

Termination of Insurance: the earlier of the member’s 65th birthday, retirement, or the spouse’s 65th birthday


Long Term Disability Insurance
                                                                        Maximum
              Class of Members                Benefit Formula         Monthly Benefit
    Eligible Maintenance and                   60% of monthly              $2,600
    Caretaking Employees (Local                   earnings
    4156)

Basic Reductions: CPP/QPP benefits (excluding benefits for dependent children), any amount payable under the
Québec Parental Insurance Plan and Workers' Compensation, Workplace Safety and Insurance Act or similar
legislation’s benefits.




Summary of Insurance (ba00s)                                                          A-1
September 1, 2010 (83620)
Total Disability and Totally Disabled: mean that,
•    during the qualifying period and the 24 month period immediately following it, you have a medical impairment
     due to injury or disease which prevents you from performing, in any setting, the essential duties of the
     occupation in which you participated just before the total disability started, and
•    after the 24 month period, you are unable, because of the medical impairment, to perform, in any setting, the
     essential duties of any occupation for which you have at least the minimum qualifications.

The medical impairment must be supported by objective medical evidence.

The availability of work for you does not affect the determination of totally disabled or total disability.
Qualifying Period: 6 months or the expiration of sick leave benefits, whichever is later
Benefit Period: To your 65th birthday, except if benefit payments begin during the 12 month period immediately
before your 65th birthday, benefit payments will continue during the disability up to a maximum of 12 months.
Termination of Insurance: 65th birthday, or date of retirement if earlier




Summary of Insurance (ba00s)                                                          A-2
September 1, 2010 (83620)
    A1        aa00s

Summary of Benefits

Plan Number 25456-3 – Health and Dental Benefits

Extended Health
                                      Deductible        Reimburse-
     Part             Benefit       per family unit        ment           Maximum
         A   Drug: Pay Direct                *               100%             --
         B   Vision: $300**               none               100%             --
         C   Hospital: ward to            none               100%             --
             semi-private
             (optional)
         D   Supp. Health Care            none               100%             --
         E   Out-of-Province              none               100%        $1,000,000***
             Emergency and
             Travel Assistance

*The dispensing fee is limited to $9.00 per prescription.
**Maximum for eyeglasses/contact lenses and laser eye surgery in any 2 consecutive calendar years for you and for
each covered dependant.
***The maximum lifetime amount payable applies to eligible expenses incurred under Part E for you and for each
covered dependant.
Other maximums are listed under the appropriate Provision page.
Termination Date:
The earlier of:
•    the end of the School Year in which you reach your 70th birthday,
•    the end of the month in which employment terminates, whichever is earlier.


Dental
                                   Deductible          Reimburse-
     Part        Benefit         per family unit          ment            Maximum
         A   Preventive               none                  100%            none
         F   Orthodontic              none                  50%            $3,000*
             Services

*The maximum lifetime amount payable applies to the eligible expenses incurred under Part F for you and for each
covered dependant.
Late Entrant Maximum: If your eligible dependant becomes covered more than 31 days after the date you became
eligible for the Dental Provision, the maximum amount payable for the combined eligible expenses of all parts
incurred during the first 12 months of coverage will be limited to $250 for each covered dependant.




Summary of Benefits (aa00s)                                                        A1-1
September 1, 2010 (25456)
Termination Date:
The earlier of:
•   the end of the School Year in which you reach your 70th birthday,
•   the end of the month in which employment terminates, whichever is earlier.
Dental Fee Guide: The applicable fee guide is the one in force for general practitioners on the day when and in the
province where the expense is incurred or, for expenses incurred outside Canada, in the province of residence of the
member. For expenses incurred in Alberta, or outside Canada by an Alberta resident, the applicable fee guide is the
1997 Alberta Fee Guide for general practitioners plus an inflationary adjustment determined by Sun Life.




Summary of Benefits (aa00s)                                                       A1-2
September 1, 2010 (25456)
 F           bf07v

General Information

Eligibility
You are eligible, and continue to be eligible, to be a member while you meet all of the following conditions:
1.    You regularly work for District School Board of Niagara and are eligible in accordance with the provisions of the
      applicable collective agreement.
2.    You are a resident of Canada.
Participation is compulsory for all benefits except Optional Life Insurance.
You are eligible, and continue to be eligible, for dependant coverage while you meet all of the following conditions:
1.    You are a member.
2.    You have at least one dependant.
3.    Your dependants are residents of Canada.


Definitions
Dependant
      means your spouse or a dependent child of you or your spouse. If Sun Life does not approve evidence of
      insurability required for a dependant, he will not be an covered dependant.

Dependent child
      means a natural, adopted or step-child who is not married or in any other formal union recognized by law, who is
      entirely dependent on you for maintenance and support and who is
     1. under 21 years of age,
     2. under 25 years of age and attending a college or university full-time, or
     3. physically or mentally incapable of self-support and became incapable to that extent while entirely dependent
        on you for maintenance and support and while eligible under 1) or 2) above.
Evidence of Insurability and Insurability
      relates only to the Provisions described in Section 1 of this booklet.

He, his and him
      refer to both genders.

Spouse
    means your spouse by marriage or under any other formal union recognized by law, or a person of the opposite or
    same sex who is living with and has been living with you in a conjugal relationship for 12 consecutive months,
    or your former spouse from whom you are separated or divorced.
      Only one person at a time can be covered as your spouse under this plan.


Enrolment
To enrol for Optional Life Insurance you must submit a completed enrolment form and evidence of insurability to Sun
Life. To enrol for Optional Dependant Life Insurance you must submit a completed enrolment form and evidence of
insurability for your spouse to Sun Life.
To enrol for all other coverage you must submit a completed enrolment form. If you have a dependant, request
dependant coverage when you enrol.



General Information (bf07v)                                                         F-1
September 1, 2010 (83620/25456)
If you have no dependant when you enrol and later acquire one, request dependant coverage, (eg. birth of first
child, marriage).
If your new dependant is a common-law spouse, see your Plan Administrator to find out how to enrol for
dependant coverage.


Effective Date
Your Optional Life Insurance is effective on the later of the date that you become eligible or the date that Sun Life
approves the evidence of insurability.
You become eligible for all other coverage on the date you become eligible.
Your dependant coverage is effective on the latest of
1.    the date that you become eligible for dependant coverage,
2.    the date that you request dependant coverage, or
3.    the date that Sun Life determines the insurability of all of your dependants, and approve at least one dependant.
If you are absent from work on the date your coverage or your dependant coverage would be effective, then that
coverage will not be effective until the date you return to active work.


Changes in Coverage
An increase in your benefits, the amount of your coverage or the amount of your dependant coverage due to change in
your group benefit plan’s design or a change in your classification becomes effective on the date of the change, unless
you are not actively working on that day due to disease or injury.
If, due to disease or injury, you are not actively working on the date an increase in your benefits, the amount of your
coverage or the amount of your dependant coverage would be effective, the increase becomes effective on the date you
return to active work. Sun Life may require evidence of insurability to establish the date that you are physically and
mentally fit to return to active work. If so, the increase becomes effective on the date Sun Life establishes. If Sun
Life doesn’t approve the evidence of insurability required, the increase will not be effective.


Comparable Coverage
If you are covered for comparable coverage under your spouse's plan, you may decline the Extended Health/Dental
coverage offered under this plan. If this comparable coverage stops you will be covered for the similar coverage
provided by this plan.
If your dependant is covered for comparable coverage under another plan, you may decline the dependant coverage for
the Extended Health/Dental coverage offered under this plan. If this comparable coverage stops, you may request the
similar coverage offered under this plan.
The coverage that replaces the comparable coverage is effective on the date that the comparable coverage stops.
If you request the dependant coverage more than 31 days after the comparable coverage stops, you are considered a
late entrant and you must submit evidence of insurability for each dependant to Sun Life. The coverage that replaces
the comparable coverage is effective on the date that Sun Life approves the evidence of insurability. If Sun Life does
not approve evidence of insurability required, the coverage will not be effective.


Termination of Coverage
Your coverage could terminate for a number of reasons. For example,
•    you are no longer eligible, (i.e. you are no longer actively working),
•    you reach the Termination Age,
•    the provision or the policy terminates.




General Information (bf07v)                                                         F-2
September 1, 2010 (83620/25456)
    G           bq02v013

Basic and Optional Member Life Insurance Provision

Benefit
The amount of benefit will be paid to your beneficiary upon your death. If no beneficiary has been appointed or if the
beneficiary has predeceased you, payment will be made to your estate.
If you become totally disabled before age 65, your Life Insurance may be continued. Premiums for the continued
insurance will be waived after you have been totally disabled from the same or related causes for six continuous
months or, if you are also insured for group Long Term Disability Insurance with Sun Life, when you begin receiving
group Long Term Disability payments.


Claims
A death claim must be received by Sun Life within 6 years of the date of death. The claimant must submit proof of
the claim and the right to receive the benefit to Sun Life.
If you become totally disabled and are also insured for group Long Term Disability Insurance with Sun Life, you must
submit a disability claim along with your claim under the group Long Term Disability Insurance to Sun Life.
If you become totally disabled and are not insured for group Long Term Disability Insurance with Sun Life, you must
submit a disability claim to Sun Life after you have been totally disabled continuously between 6 and 12 months.
There is a time limit for proceedings against Sun Life for payment of a claim. A proceeding must be started within 1
year of Sun Life’s receipt of the proof of claim.


At Termination
If your Life Insurance terminates because you are no longer eligible, and this provision continues in force, you may
convert it to an individual policy on your life up to the lesser of
•       the amount of the insurance terminated,
•       the maximum amount of insurance for which you have been insured under this provision less the total amount of
        individual insurance still in force on your life which was previously obtained through the Conversion Privilege of
        this provision, or
•        $200,000 (Basic and Optional Life Insurance combined).

If your insurance terminates while this provision continues in force and you die within 31 days after termination of
insurance, the amount of insurance terminated will be paid to your beneficiary.
If your Life Insurance terminates because this provision terminates, and you have been continuously insured under
this provision for the five year period before the termination of this provision, you may convert it to an individual
policy on your life up to the lesser of
•       the amount of the insurance terminated less the amount of insurance in force under a new group policy that
        replaces this policy, or
•       3 times the Year's Maximum Pensionable Earnings as established under the Canada Pension Plan in the year that
        this provision terminated.
If you convert your Life Insurance, you must apply and pay the premium to Sun Life within 31 days after termination
of insurance.
If you have any questions about this conversion privilege, please contact your plan administrator or the nearest Sun
Life office.




Basic and Optional Member Life Insurance Provision (bq02v013)                          G-1
September 1, 2010 (83620)
 H          bh01v009

Optional Dependant Life Insurance Provision

Benefit
The amount of benefit will be paid to you upon the death of your insured dependant.
For Optional Spouse Life Insurance, if you have appointed a beneficiary, the amount of benefit will be paid to the
beneficiary upon the death of your insured spouse.
If you become totally disabled, your Dependant Life Insurance may be continued without payment of premiums as
long as your Member Life Insurance premiums are waived.


Claims
A claim must be received by Sun Life within 6 years of the date of death. You must submit proof of claim and the
right to receive the benefit to Sun Life.
There is a time limit for proceedings against Sun Life for payment of a claim. A proceeding must be started within 1
year of Sun Life’s receipt of the proof of claim.


At Termination
If your Dependant Life Insurance for your spouse terminates due to the termination of your Member Life Insurance
and this provision continues in force, your spouse may convert the amount of the dependant insurance terminated to
an individual policy on his/her life.
Your spouse must apply and pay the premium to Sun Life within 31 days after termination of insurance.
If your Dependant Life Insurance terminates while this provision continues in force and your spouse dies within 31
days after termination of insurance, the amount of insurance which your spouse could have converted to an individual
policy on his/her life through the Conversion Privilege of this provision will be paid to you.




Optional Dependant Life Insurance Provision (bh01v009)                            H-1
September 1, 2010 (83620)
    L           bl02v012

Long Term Disability Insurance Provision

Benefit
The amount of monthly disability benefit will be paid to you when proof is received by Sun Life that you are absent
from active work because you are totally disabled and that you have been totally disabled from the same or related
causes for the qualifying period.
Benefits are payable from the later of
•       one month after the end of the qualifying period, or
•       one month after the date you are no longer entitled to receive regular earnings or benefits under a salary
        continuance plan or short term disability income plan.
If you are receiving disability income or retirement income from other sources, the monthly disability benefit will be
reduced so that the total amount of income receivable by you from all sources does not exceed 85% of your monthly
rate of earned income in force on the date you became totally disabled.
If the benefit is not subject to income tax, the monthly rate of earned income, for the purposes of this section, is
reduced by income tax deductions.
If you become totally disabled, your Long Term Disability Insurance may be continued without payment of premiums
while you are receiving Long Term Disability benefit payments.


Rehabilitation
If your total disability prevents you from returning to work, Sun Life may be able to assist you by providing a
rehabilitation program that will help you return to the workforce. A rehabilitation program is limited to one or more
of the following:
1.       assessment,
2.       counselling,
3.       vocational retraining or an educational program,
4.       trial work, part-time or modified work.
If, after qualifying for benefits, you are receiving income from an approved rehabilitation program, your monthly
disability benefit is reduced by 50% of that income. Your monthly disability benefit is further reduced so that the
total income from all sources does not exceed 100% of your
•        gross monthly earnings in force on the date you became totally disabled, if the benefit is subject to income tax,
         or
•        net monthly earnings, in force on the date you became totally disabled, if the benefit is not subject to income tax.
Example:
   Assume you are earning $2,000/month and have a 66 2/3% LTD benefit ($1,334.00). Rehabilitation income
   from your employer is $1,000/month. There is no income from other sources.

Rehabilitation Income + (Monthly Disability Benefit - 50% of Rehabilitation Income)
= $1,000 + ($1,334.00 - {50% of $1,000})
= $1,000 + $834.00
= $1,834.00
Since the benefit ($1,834.00/month) does not exceed your pre-disability monthly earnings ($2,000/month), there will
be no reductions due to the 100% all source maximum.
If you are participating in a rehabilitation program approved by Sun Life, you continue to be considered totally
disabled.




Long Term Disability Insurance Provision (bl02v012)                                     L-1
September 1, 2010 (83620)
Subrogation
Subrogation is a legal practice giving Sun Life the right to be reimbursed for benefits paid to you if you have been
compensated by another person who is responsible for your loss. The intent of subrogation is to limit your benefit
payments to the amount you actually lost.
Let's assume a person is responsible for your disability, and is required to compensate you for any of the loss that
results from your disability. If Sun Life is paying or has paid your loss of income benefits, you may be receiving more
income than you earned before you became disabled. In that case, you would reimburse us for the loss of income
benefits we have paid. If you receive an amount for future loss of income, that amount will reduce your future loss of
income benefits from Sun Life.
If subrogation applies to your claim, we will contact you to obtain the information required to proceed. You will be
required to sign an undertaking to reimburse us for any amount recovered which exceeds 100% of income or
expenses. Before agreeing to a settlement of your claim, Sun Life’s approval must be obtained.


Claims
A claim must be received by Sun Life within 3 months after the end of the qualifying period. The qualifying period
begins on the date you become totally disabled. Proof of continuing disability may be required each year.
There is a time limit for proceedings against Sun Life for payment of a claim. A proceeding must be started within 1
year of Sun Life’s receipt of the proof of claim.


At Termination
If this Long Term Disability provision terminates while you are totally disabled, you will continue to be eligible for
this benefit as if it were still in force.


Exclusions and Limitations
No benefit is payable for a disability due to
•   intentionally self-inflicted injuries,
•   civil disorder or war, whether or not war was declared,
•   committing or attempting to commit a criminal offence.
You are not considered totally disabled unless you are under the active and continuous care of a physician whom Sun
Life considers to be appropriate to your total disability and you are following the treatment prescribed by the
physician for that disability.
You are not considered totally disabled due to the use of drugs or alcohol unless you are being actively supervised by
and receiving continuous treatment for that disability from a rehabilitation centre or an institution provincially
designated for that treatment.




Long Term Disability Insurance Provision (bl02v012)                                 L-2
September 1, 2010 (83620)
 M          am01v032

Extended Health Provision

Benefit
You will be reimbursed when you submit proof to Sun Life that you or your covered dependant has incurred any of
the eligible expenses for medically necessary services required for the treatment of disease or bodily injury. To
determine the amount payable, the total amount of eligible expenses you claim will be adjusted as follows:
1.   the maximums described throughout the extended health benefit provisions are applied,
2.   then the deductible, which must be satisfied each calendar year, is subtracted, and
3.   the reimbursement percentage is applied.

Example:

Assume that your plan has a $25 deductible and a reimbursement level of 80%. The maximum that your plan covers
for eyeglasses is $175 every 24 month period. You have submitted an eyeglass claim for $100. This is the first
extended health claim you have submitted this year so the deductible does need to be paid by you.
To determine the amount that you would be refunded for this claim:
1.   The maximum eligible amount under the plan is $175. Therefore, the amount of the claim that will be
     considered for payment is $175.
2.   The $25 deductible is applied to the submitted amount of $100. The amount has now been reduced to $75.
3.   The reimbursement level is 80%. This means that 80% of the remaining $75 will be refunded to you. 80% of
     $75 is $60. $60 will be paid to you for this eyeglass claim.
4.   The maximum eligible amount under the plan is $175. $175 less the $100 that you submitted for this eyeglass
     claim is $75. This means that $75 will still be considered for payment for other eyeglass expenses during this
     24 month period.

The intentional omission, misrepresentation or falsification of information relating to any claim constitutes fraud.


Co-ordination of Benefits
If you or your dependants are covered under this plan and another plan, Sun Life will co-ordinate benefits under this
plan with the other plan following insurance industry standards. These standards determine which plan you should
claim from first.

The plan that does not contain a co-ordination of benefits clause is considered to be the first payer and therefore pays
benefits before a plan which includes a co-ordination of benefits clause.

For dental accidents, health plans with dental accident coverage pay benefits before dental plans.

Following payment under another plan, the amount of benefit payable under this plan will not exceed the total
amount of eligible expenses incurred less the amount paid by the other plan.

Where both plans contain a co-ordination of benefits clause, claims must be submitted in the order described below.

Claims for you and your spouse should be submitted in the following order:
1. the plan where the person is covered as an employee. If the person is an employee under two plans, the following
    order applies:
     •    the plan where the person is covered as an active full-time employee,
     •    the plan where the person is covered as an active part-time employee,
     •    the plan where the person is covered as a retiree.
2.   the plan where the person is covered as a dependant.




Extended Health Provision (am01v032)                                                M-1
September 1, 2010 (25456)
Claims for a dependent child should be submitted in the following order:
1.   the plan where the dependent child is covered as an employee,
2.   the plan where the dependent child is covered under a student health or dental plan provided through an
     educational institution,
3.   the plan of the parent with the earlier birth date (month and day) in the calendar year,
4.   the plan of the parent whose first name begins with the earlier letter in the alphabet, if the parents have the same
     birth date.

The above order applies in all situations except when parents are separated/divorced and there is no joint custody of
the dependent child, in which case the following order applies:
1. the plan of the parent with custody of the dependent child,
2. the plan of the spouse of the parent with custody of the dependent child,
3. the plan of the parent not having custody of the dependent child,
4. the plan of the spouse of the parent not having custody of the dependent child.

When you submit a claim, you have an obligation to disclose to Sun Life all other equivalent coverage that you or
your dependants have.


Claims
A claim must be received by Sun Life within 18 months of the date that the expense is incurred. However, if your
coverage terminates, any claim must be received by Sun Life no later than 90 days following the end of the coverage.
For the assessment of a claim, itemized bills, attending physician statements or other necessary information are
required.
If your physician is recommending medical treatment that is expected to cost more than $1,000, you should request
pre-authorization to ensure that the expenses are covered.
There is a time limit for proceedings against Sun Life for payment of a claim. A proceeding must be started within 1
year of Sun Life’s receipt of the proof of claim.


Exclusions
No benefit is payable for
•    expenses for which benefits are payable under a Workers' Compensation Act, Workplace Safety and Insurance
     Act or a similar statute,
•    expenses incurred due to intentionally self-inflicted injuries,
•    expenses incurred due to civil disorder or war, whether or not war was declared,
•    expenses for services and products, rendered or prescribed by a person who is ordinarily a resident in the
     patient's home or who is related to the patient by blood or marriage,
•    expenses for which benefits are payable under a government plan,
•    expenses for benefits which are legally prohibited by the government from coverage,
•    out-of-province expenses for elective (non-emergency) medical treatment or surgery.


At Termination
If, on the date of termination of your coverage,
•    you have a medically determinable physical or mental impairment due to injury or disease which prevents you
     from performing the regular duties of the occupation in which you participated just before the impairment
     started, regardless of the availability of work for you, or
•    your covered dependant has a medically determinable physical or mental impairment due to injury or disease, is
     receiving treatment from a physician and is confined to a hospital or his home,



Extended Health Provision (am01v032)                                                 M-2
September 1, 2010 (25456)
benefits will be payable for eligible expenses related to the impairment provided they are incurred within 90 days of
the date of termination and this provision continues in force.
If you die, your covered dependant's Extended Health Benefits will be continued for 3 months, as long as the
Extended Health provision remains in force. Your dependants must contact your Plan Administrator to arrange the
extension of coverage.


My Health CHOICE Coverage
If your coverage under this plan terminates, you may purchase Sun Life's My Health CHOICE coverage. This
coverage is different from your group plan.
To be eligible, you must:
•   apply for My Health CHOICE coverage within 60 days after the termination of your coverage, and
•   be a resident of Canada and covered under the provincial health plan.

My Health CHOICE coverage may also include Dental coverage if you had both Extended Health and Dental Benefits
under this group plan, and both benefits terminated.
You may cover your spouse and dependants if those family members were covered under your group plan.
If you have any questions about this product, please call our Customer Solutions Centre at 1-877-893-9893 Monday to
Friday, 8:00 am to 8:00 pm EST.




Extended Health Provision (am01v032)                                              M-3
September 1, 2010 (25456)
 N          anpdv84g

Extended Health - Pay Direct Drug Benefit

Eligible Expenses
Eligible expenses mean reasonable and customary charges for the following items of expense, provided they are
prescribed by a physician or dentist and dispensed by a registered pharmacist.
1.   drugs which legally require a prescription and are identified in the Monographs section of the current
     Compendium of Pharmaceuticals and Specialties as a narcotic, controlled drug, or requiring a prescription.
2.   life-sustaining drugs which may not legally require a prescription and are identified in the Therapeutic Guide
     section of the current Compendium of Pharmaceuticals and Specialties under the following headings:
     •     anti-anginal agents
     •     antiparkinsonism agents
     •     bronchodilators
     •     antihyperlipidemic agents
     •     hyperthyroidism therapy
     •     parasympathomimetic agents
     •     tuberculosis therapy
     •     anticholinergic preparations
     •     anti-arrhythmic agents
     •     glaucoma therapy
     •     insulin preparations
     •     oral fibrinolytic agents
     •     potassium replacement therapy
     •     topical enzymatic debriding agents
3.   injectible drugs.
4.   compounded prescriptions where one of the ingredients is an eligible expense.
5.   needles, syringes, and chemical diagnostic aids for the treatment of diabetes.
6.   drugs used for the treatment of erectile dysfunction, limited to a calendar year maximum of $1,200.

Generic Substitution
The maximum amount payable for an eligible brand name drug will be limited to the lowest priced item in the
appropriate generic category.


Drug Utilization Review (DUR)
Sun Life provides a Drug Utilization Review (DUR) service to ensure the safe and effective use of drugs prescribed
for you and your insured dependant. Your pharmacist will review an eligible drug against your past drug claims for
possible harmful effects to your health, such as a severe drug interaction.


Claims
Claims for the above eligible expenses are submitted using a Pay Direct Drug card.
Claims for the following eligible expenses must be submitted directly to Sun Life by the member:
1.   patent drugs, provided a physician certifies in writing that the drugs are required for continuous treatment of an
     ongoing disease or medical condition.


Other Health Professionals Allowed to Prescribe Drugs
Certain drugs prescribed by other qualified health professionals will be reimbursed the same way as if the drugs were
prescribed by a physician or a dentist if the applicable provincial legislation permits them to prescribe those drugs.




Extended Health - Pay Direct Drug Benefit (anpdv84g)                                N-1
September 1, 2010 (25456)
Limitations and Exclusions
No benefit is payable for
1.   the portion of expenses for which reimbursement is provided by a government plan,
2.   the yearly or per prescription deductible on drugs that are eligible under the Ontario Drug Benefit plan and are
     purchased by you or your insured spouse who is age 65 or over,
3.   expenses for drugs which do not legally require a prescription, except those specified under Eligible Expenses,
4.   expenses for drugs which, in Sun Life's opinion, are experimental,
5.   expenses for dietary supplements, vitamins and infant foods,
6.   expenses for contraceptives, other than oral,
7.   expenses for drugs which are used for cosmetic purposes,
8.   expenses for drugs for the treatment of obesity, and
9.   expenses incurred under any of the conditions listed on the Extended Health Provision page as an Exclusion.




Extended Health - Pay Direct Drug Benefit (anpdv84g)                               N-2
September 1, 2010 (25456)
 O          ao01v032

Extended Health - Vision Care Benefit

Definitions
Laser Eye Surgery
     means the expenses incurred for laser eye surgery performed by an ophthalmologist licensed to practice
     ophthalmology, limited to the maximums and reimbursement percentage specified in the Summary of Benefits
     for the vision care benefit. You, or your covered dependant who has received reimbursement for laser eye
     surgery, will not be eligible for eyeglasses and contact lenses expenses during the same vision benefit period
     following the surgery.
Ophthalmologist
     means a person licensed to practise ophthalmology.
Optometrist
     means a member of the Canadian Association of Optometrists or of a provincial association associated with it.
Reasonable and customary charges
     mean those which are usually made to a person without coverage for the items of expense listed under Eligible
     Expenses and which do not exceed the general level of charges in the area where the expense is incurred or, for
     eligible expenses incurred outside Canada, the general level of charges for comparable services in the area
     where the member normally resides.


Eligible Expenses
Eligible expenses are the reasonable and customary charges for the following items of expense:
1. eye examinations by an optometrist limited to one exam in a 24 month period (12 month period for a covered
   dependant under age 18).
2. eyeglasses and contact lenses and repairs to them, and laser eye surgery that are necessary for the correction of
   vision and are prescribed by an ophthalmologist or optometrist, limited to the maximum specified in the Summary
   of Benefits for eligible expenses incurred during the previous 2 calendar years for the member and each covered
   dependant.
3. eyeglasses and contact lenses certified by an ophthalmologist as necessary due to a surgical procedure or the
   treatment of keratoconus, limited to $150 for the non-surgical treatment of keratoconus for the lifetime of the
   member and each covered dependant and $150 for each surgical procedure.


Exclusion
No benefit is payable for
1.   expenses incurred under any of the conditions listed on the Extended Health Provision page as an Exclusion


Preferred Vision Services (PVS)
The Preferred Vision Services (PVS) vision care program enables you to purchase eyewear at savings of up to 20%
and save 10% on laser eye correction surgery. Savings on eyewear are available on all frames, prescription lenses and
lens add-ons at registered PVS locations and online suppliers. Most locations will also apply the discount to non-
prescription eyewear and accessory items. Discounts for laser eye correction surgery only apply to service providers
registered in the PVS network.




Extended Health - Vision Care Benefit (ao01v032)                                   O-1
September 1, 2010 (25456)
PVS locations can be identified by calling the PVS information centre toll-free number 1-800-668-6444, or visiting
the PVS website at www.pvs.ca. After selecting your eyewear, but before the purchase, tell the practitioner that you
are covered under a plan through Sun Life (proof of plan membership may be required) and pay the reduced price. If
you are considering laser eye correction surgery with a PVS provider, identify yourself as a Sun Life plan member
with PVS coverage when booking your consultation appointment.
This PVS program provision applies if your plan has extended health coverage. You do not have to be covered for
Vision Care benefits to receive the discount. If your plan includes vision care coverage, submit your claim to Sun
Life. Visit the PVS website for more details about the program and to find a provider.




Extended Health - Vision Care Benefit (ao01v032)                                  O-2
September 1, 2010 (25456)
 P          ap01v032

Extended Health - Supplementary Hospital Benefit

Definitions
Hospital
     means a legally licensed hospital which provides facilities for diagnosis, major surgery and the care and
     treatment of a person suffering from disease or injury, on an in-patient basis, with 24 hour services by registered
     nurses and physicians. This includes legally licensed hospitals providing specialized treatment for mental
     illness, drug and alcohol addiction, cancer, arthritis and convalescing or chronically ill persons when approved
     by Sun Life. This does not include nursing homes, homes for the aged, rest homes or other places providing
     similar care.
Reasonable and customary charges
     mean those which are usually made to a person without coverage for the items of expense listed under Eligible
     Expenses and which do not exceed the general level of charges in the area where the expense is incurred.


Eligible Expenses
Eligible expenses mean reasonable and customary charges for accommodation in a hospital, limited to the difference
between the charges for public ward and semi-private room for each day of hospitalization. Coverage is provided for
semi-private room both inside and outside the member’s province of residence and Canada.


Exclusion
No benefit is payable for
1.   Expenses incurred under any of the conditions listed on the Extended Health Provision page as an exclusion.




Extended Health - Supplementary Hospital Benefit (ap01v032)                         P-1
September 1, 2010 (25456)
 Q           aq04v015

Extended Health - Supplementary Health Care Benefit

Definitions
Chiropodist
     means a person licensed by the appropriate provincial licensing authority.
Chiropractor
     means a member of the Canadian Chiropractic Association or of a provincial association affiliated with it.
Hospital
     means a legally licensed hospital which provides facilities for diagnosis, major surgery and the care and
     treatment of a person suffering from disease or injury, on an in-patient basis, with 24 hour services by registered
     nurses and physicians. This includes legally licensed hospitals providing specialized treatment for mental
     illness, drug and alcohol addiction, cancer, arthritis and convalescing or chronically ill persons when approved
     by Sun Life. This does not include nursing homes, homes for the aged, rest homes or other places providing
     similar care.
Naturopath
     means a member of the Canadian Naturopathic Association or any provincial association affiliated with it.

Osteopath
     means a person who holds the degree of doctor of osteopathic medicine from a college of osteopathic medicine
     approved by the Canadian Osteopathic Association or a person who holds a Diploma in Osteopathic Manual
     Practice (DOMP) and is recognized by the Ontario Association of Osteopaths.
Physiotherapist
     means a member of the Canadian Physiotherapy Association or of a provincial association affiliated with it.
Podiatrist
     means a member of the Canadian Podiatric Association or of a provincial association affiliated with it.
Psychologist
     means a permanently certified psychologist who is listed on the appropriate provincial registry in the province in
     which the service is rendered.
Reasonable and customary charges
     mean those which are usually made to a person without insurance for the items of expense listed under Eligible
     Expenses and which do not exceed the general level of charges in the area where the expense is incurred.
Registered Massage Therapist
     means a person licensed by the appropriate provincial licensing body or in the absence of a provincial licensing
     body, a person whose qualifications we determine to be comparable with those required by a licensing body.
Registered Nurse
     means a nurse who is listed on the appropriate provincial registry.
Speech Therapist
     means a person who holds a diploma or degree in Speech Therapy from a recognized university.




Extended Health - Supplementary Health Care Benefit (aq04v015)                      Q-1
September 1, 2010 (25456)
Eligible Expenses
To be eligible, the expenses must be medically necessary for the treatment of disease or injury and prescribed by a
physician, unless otherwise specified.
Eligible expenses are the reasonable and customary charges for the items of expense listed below.
1. the services of a registered nurse (R.N.) provided in the patient's home.
2. rental, or purchase at Sun Life’s option, of wheel chair, hospital bed, walker and other durable equipment
   approved by Sun Life and required for temporary therapeutic use.
3. trusses, crutches and braces, with a limit of 4 pairs of elastic support stockings in a calendar year.
4. artificial limbs or other prosthetic appliances, including colostomy supplies, and following a mastectomy, two
   surgical brassieres in any calendar year.
5. oxygen.
6. diagnostic laboratory and x-ray examinations.
7. licensed ground ambulance service to the nearest hospital equipped to provide the required treatment, when the
   physical condition of the patient prevents the use of another means of transportation.
8. emergency ambulance service by a licensed ambulance, air ambulance, or by any other vehicle normally used for
   public transportation, to the nearest hospital equipped to provide the required treatment, limited to one return trip
   in a calendar year and limited to the charge made in the area where the expense is incurred. Licensed ground
   ambulance service to and from the points of departure and arrival is also considered eligible.
9. hearing aids and repairs to them, excluding batteries.
10. wigs, as a result of chemotherapy.
11. the following hospital and medical services which are not offered in the province of residence and are performed
    following written referral by the attending physician in the patient's province of residence.
     a. public ward accommodation and auxiliary hospital services in a general hospital limited to, after deducting
        the amount payable by a government plan, $75 a day for 60 days in a calendar year.
     b. services of a physician limited to, after deducting the amount payable by a government plan, the level of
        physicians' charges in the patient's province of residence.
      Items of expense incurred outside Canada are eligible only if they are not offered in any province in Canada
Eligible expenses are the reasonable and customary charges for the following items of expense listed below:
1.    services of a dental surgeon, including dental prosthesis, required for the treatment of a fractured jaw or for the
      treatment of accidental injures to natural teeth if the fracture or injury was caused by external, violent and
      accidental means, provided the services are performed within 6 months of the accident.
2.    services of a chiropodist, chiropractor, osteopath and naturopath, provided no portion of a charge for these
      services is payable under a government plan, limited to $25 per visit and $250 in a calendar year for each
      practitioner. X-ray examinations taken by a chiropractor or osteopath are limited to $15 in a calendar year.
3.    services of a podiatrist, provided no portion of a charge for these services is payable under a government plan,
      limited to $25 per treatment and $250 in a calendar year. Services for surgical removal of the toe nails or
      plantar warts limited to $100 in a calendar year. X-ray examinations taken by a podiatrist are limited to $15 in a
      calendar year.
4.    services of a physiotherapist limited to $30 per visit and $300 in a calendar year.
5.    services of a massage therapist limited to $30 per visit and $300 in a calendar year.
6.    services of a speech therapist, limited to $25 for the initial assessment and $20 per visit for treatment or therapy,
      limited to $200 in a calendar year.
7.    services of a psychologist, limited to $10 per one-half hour for the initial assessment and $10 per visit for
      treatment or therapy, limited to $200 in a calendar year.



Extended Health - Supplementary Health Care Benefit (aq04v015)                        Q-2
September 1, 2010 (25456)
     The practitioner must be registered with the appropriate association or registry. Where applicable, expenses for
     practitioners' services eligible under a provincial health care plan will not be reimbursed until your expenses
     exceed the annual maximums under your provincial plan
8.   custom made orthopaedic shoes, orthopaedic modifications to shoes and orthotics when they are required for the
     correction of deformity of bones and muscles and provided they are not soley for athletic use and are prescribed
     by a physician. Orthotics are limited to a maximum of $250 per foot in a 24 month period.
9.   hospital room and board charges for convalescent or chronic care limited to $20 per day for each day of
     confinement.




Extended Health - Supplementary Health Care Benefit (aq04v015)                    Q-3
September 1, 2010 (25456)
 Q1          aqtops33

Extended Health - Out-of-Province Emergency and Travel Assistance
Benefit
To be covered for this benefit, you and your covered dependant must have provincial health care coverage. Expenses
for hospital/medical services and travel assistance benefits are eligible if
1.    they are incurred as a result of emergency treatment of a disease or injury which occurs outside your home
      province,
2.    they are medically necessary, and
3.    they are incurred due to an emergency which occurs during the first 60 days of travelling on vacation or business
      outside your home province. Your 60 days of coverage starts on the day you or your covered dependant departs
      from your home province.


Definitions
Emergency
   means an acute illness or accidental injury that requires immediate, medically necessary treatment prescribed by
   a physician.

Emergency services
   mean any reasonable medical services or supplies, including advice, treatment, medical procedures or surgery,
   required as a result of an emergency. When you or your covered dependant have a chronic condition, emergency
   services do not include treatment provided as part of an established management program that existed prior to
   leaving your province of residence.

Family member
   means you or your covered dependant.

Reasonable and customary charges
    mean those which are usually made to a person without coverage for the items of expense listed under Eligible
    Expenses and which do not exceed the general level of charges in the area where the expense is incurred.

Relative
    means your spouse, parent, child, brother or sister.


Emergency Services
At the time of an emergency, the family member or someone with the family member must contact Sun Life's
Emergency Travel Assistance provider, Europ Assistance USA, Inc. (Europ Assistance). All invasive and
investigative procedures (including any surgery, angiogram, MRI, PET scan, CAT scan), must be pre-authorized by
Europ Assistance prior to being performed, except in extreme circumstances where surgery is performed on an
emergency basis immediately following admission to a hospital.
If contact with Europ Assistance cannot be made before services are provided, contact with Europ Assistance must be
made as soon as possible afterwards. If contact is not made and emergency services are provided in circumstances
where contact could reasonably have been made, then we have the right to deny or limit payments for all expenses
related to that emergency.
An emergency ends when the family member is medically stable to return to his province of residence.


Emergency Services Excluded from Coverage
Any expenses related to the following emergency services are not covered:
1. services that are not immediately required or which could reasonably be delayed until the family member returns
   to his province of residence, unless his medical condition reasonably prevents him from returning to his province
   of residence prior to receiving the medical services.


Extended Health - Out-of-Province Emergency and Travel Assistance Benefit (aqtops33)                               Q1-1
September 1, 2010 (25456)
2. services relating to an illness or injury which caused the emergency, after such emergency ends.
3. continuing services arising directly or indirectly out of the original emergency or any recurrence of it, after the
   date that we or Europ Assistance, based on available medical evidence, determines that the family member can be
   returned to his province of residence, and he refuses to return.
4. services which are required for the same illness or injury for which the family member received emergency
   services, including any complications arising out of that illness or injury, if the family member had unreasonably
   refused or neglected to receive the recommended medical services.
5. where the trip was taken to obtain medical services for an illness or injury, services related to that illness or
   injury, including any complications or any emergency arising directly or indirectly out of that illness or injury.


Eligible Expenses for Hospital/Medical Services
Eligible expenses mean reasonable and customary charges for the following items of expense incurred for emergency
services, less the amount payable by a government plan:
1.   public ward accommodation and auxiliary hospital services in a general hospital,
2.   services of a physician,
3.   economy air fare for the patient's return to his province of residence for medical treatment,
4.   licensed ground ambulance service to the nearest hospital equipped to provide the required treatment, or to
     Canada, when the patient's physical condition prevents the use of another means of transportation,
5.   emergency air ambulance service to the nearest hospital equipped to provide the required treatment, or to
     Canada, when the patient's physical condition prevents the use of another means of transportation, and if the
     patient requires a registered nurse during the flight, the services and return air fare for the registered nurse.
The maximum lifetime amount payable for the above Eligible Expenses is $1,000,000 for you and for each covered
dependant.
Expenses that are included as Eligible Expenses under Drug, Vision, Hospital or Supplementary Health Care benefits
are also eligible while you or your covered dependant is travelling outside Canada. These expenses are subject to the
deductibles and reimbursement percentages listed under the appropriate benefit in the Summary of Benefits.


Eligible Expenses for Travel Assistance Benefits
Eligible expenses mean reasonable and customary charges for the following items of expense incurred for emergency
services:
1.   family assistance benefits, which include reimbursement for the cost of:
     a.   return transportation for covered dependent children who are under the age of 16, or who are handicapped,
          if they are left unattended because you or your spouse is hospitalized outside your province of residence.
          We will arrange the transportation of the dependent child to your home, and if necessary, an escort will be
          provided to accompany him. The maximum payable for the return transportation is a one-way economy fare
          for each dependent child.
     b.   return transportation for family members, if the hospitalization of a family member prevents them from
          returning home on the originally scheduled, pre-paid transportation, and consequently requires them to
          purchase new return tickets. The extra cost of each return fare is payable to a maximum of a one-way
          economy fare, less any amount reimbursed for the unused, return tickets.
     c.   visit of one relative, if a family member is hospitalized for more than 7 days while travelling without a
          relative. This includes meals and accommodation up to a maximum of $150 per day, and round-trip
          economy transportation, for one relative. These expenses are also covered when it is necessary for a
          relative to identify a deceased family member before the release of his body.
     d.   meals and accommodation up to a maximum of $150 per day per family, if a trip is extended because a
          family member is hospitalized.
     The combined maximum amount payable for the above family assistance benefits is $5,000 for one travel
     emergency.




Extended Health - Out-of-Province Emergency and Travel Assistance Benefit (aqtops33)                                  Q1-2
September 1, 2010 (25456)
2.   return of a deceased family member. The necessary authorizations will be obtained and arrangements made for
     the return of the deceased to his province of residence. The maximum amount payable for the preparation and
     return of the deceased is $5,000. Preparation of the deceased includes expenses for cremation at the place of
     death. Return of the deceased includes a basic shipping container, but excludes expenses for burial, such as
     burial caskets and urns.
3.   return of a vehicle. If a family member is unable to operate a vehicle (owned or rented) because he is being
     returned to Canada for medical treatment, Sun Life will administer reimbursement of the cost of returning this
     vehicle to his province of residence, or the nearest appropriate rental agency. This benefit is also payable in the
     event of a family member's death. The maximum amount payable for returning the vehicle is $1,000.


Travel Assistance Services
Out-of-province and around-the-world services are provided through Europ Assistance USA, Inc., a company
specializing in emergency medical assistance for travellers. By calling the 24 hour helpline, Europ Assistance will be
able to provide you and your covered dependants with the following emergency assistance services during the first 60
days of travel:
1.   physician and hospital referrals,
2.   on-going monitoring of medical treatment if a family member is hospitalized,
3.   coordination of transportation arrangements via ground or air ambulance if it is medically necessary to return a
     family member to Canada or transfer him to another hospital that is equipped to provide the required treatment,
4.   payment assistance for hospital/medical expenses,
5.   legal referrals,
6.   a telephone interpretation service,
7.   a message service for you, your family, friends and business associates.


Emergency Payment Assistance

Eligible Hospital/Medical Expenses:
To ensure payment of these expenses,
1.   Call the 24 hour helpline immediately. If you are physically unable to call the helpline yourself, then have a
     family member, travelling companion or medical personnel call for you. Simply showing your Sun Life travel
     assistance card to a doctor, nurse or hospital personnel will NOT ensure payment of these expenses.
2.   Europ Assistance will verify your extended health coverage and provincial health care coverage so payments can
     be arranged on behalf of you or your covered dependant.
3.   You will be required to sign an authorization form allowing Europ Assistance to recover any amounts payable by
     the provincial health care plan.
4.   For expenses that require a percentage paid by you, or that are not covered under this plan or the provincial
     health care plan, you must reimburse us for the excess amount of the payment.
5.   If you receive any subsequent bills for these expenses, please forward them to Europ Assistance and they will
     coordinate payments with the provincial health care plan and Sun Life.


24 Hour Helpline
If emergency assistance is needed, a 24 hour helpline is available. Multilingual coordinators at Europ Assistance can
access a worldwide network of professionals who offer help with medical, legal, and other travel-related emergencies.
The 24 hour helpline can assist you and your covered dependant if you have lost your passport or visa, if you need to
find a local legal advisor, or if you require telephone interpretation services. You can also call the helpline and leave
important messages for family, friends or business associates; likewise, they can call the helpline and leave messages
for you while you travel. Europ Assistance will hold such messages for 15 days.




Extended Health - Out-of-Province Emergency and Travel Assistance Benefit (aqtops33)                                 Q1-3
September 1, 2010 (25456)
When calling the 24 hour helpline, please be ready to state your Plan No., Certificate No., ID No., and Provincial
Medical Insurance Plan/Health Card Number.
Please consult the telephone numbers on your travel assistance card.


Exclusions and Limitations
No benefit is payable for
1.   expenses incurred by you or your covered dependant due to an emergency which occurs more than 60 days after
     departure from your province of residence,
2.   expenses incurred on a non-emergency or referral basis,
3.   expenses incurred under any of the conditions listed as an Exclusion in the Extended Health Provision.
If you are covered as a retired employee, you and your covered dependants must return to your province of residence
for at least 30 consecutive days before becoming eligible for another 60 days of coverage.
Due to conditions such as war, political unrest, epidemics, and geographic inaccessibility, emergency assistance
services may not be available in certain countries. For more information on travelling conditions and the availability
of Europ Assistance services in a particular country, please call the appropriate 24 hour helpline.
Neither we nor Europ Assistance is responsible for the availability, quality or results of the medical treatment
received by the family member, or for the failure to obtain medical treatment.




Extended Health - Out-of-Province Emergency and Travel Assistance Benefit (aqtops33)                               Q1-4
September 1, 2010 (25456)
 R          ar01v010

Dental Provision

Benefit
You will be reimbursed when you submit proof to Sun Life that you or your covered dependant has incurred any of
the eligible expenses for necessary dental services performed by a dentist, a dental hygienist or a denturist. To
determine the amount payable, the total eligible expenses claimed are adjusted as follows:
1. the deductible, which must be satisfied each year, is subtracted,
2. the reimbursement percentage is applied, and
3. the maximums specified in the Summary of Benefits are applied.
The intentional omission, misrepresentation or falsification of information relating to any claim constitutes fraud.
Sun Life reserves the right to refuse any assignment of benefits under this provision.


Co-ordination of Benefits
If you or your dependants are covered under this plan and another plan, Sun Life will co-ordinate benefits under this
plan with the other plan following insurance industry standards. These standards determine which plan you should
claim from first.

The plan that does not contain a co-ordination of benefits clause is considered to be the first payer and therefore pays
benefits before a plan which includes a co-ordination of benefits clause.

For dental accidents, health plans with dental accident coverage pay benefits before dental plans.

Following payment under another plan, the amount of benefit payable under this plan will not exceed the total
amount of eligible expenses incurred less the amount paid by the other plan.

Where both plans contain a co-ordination of benefits clause, claims must be submitted in the order described below.

Claims for you and your spouse should be submitted in the following order:
1. the plan where the person is covered as an employee. If the person is an employee under two plans, the following
    order applies:
     •    the plan where the person is covered as an active full-time employee,
     •    the plan where the person is covered as an active part-time employee,
     •    the plan where the person is covered as a retiree.
2.   the plan where the person is covered as a dependant.

Claims for a dependent child should be submitted in the following order:
1.   the plan where the dependent child is covered as an employee,
2.   the plan where the dependent child is covered under a student health or dental plan provided through an
     educational institution,
3.   the plan of the parent with the earlier birth date (month and day) in the calendar year,
4.   the plan of the parent whose first name begins with the earlier letter in the alphabet, if the parents have the same
     birth date.

The above order applies in all situations except when parents are separated/divorced and there is no joint custody of
the dependent child, in which case the following order applies:
1.   the plan of the parent with custody of the dependent child,
2.   the plan of the spouse of the parent with custody of the dependent child,


Dental Provision (ar01v010)                                                          R-1
September 1, 2010 (25456)
3.   the plan of the parent not having custody of the dependent child,
4.   the plan of the spouse of the parent not having custody of the dependent child.

When you submit a claim, you have an obligation to disclose to Sun Life all other equivalent coverage that you or
your dependants have.


Claims
A claim must be received by Sun Life within 18 months of the date the expense is incurred. However, if your
coverage terminates, any claim must be received by Sun Life no later than 90 days following the end of the coverage.
For the assessment of a claim, itemized bills, commercial laboratory receipts, reports, records, pre-treatment x-rays,
study models, independent treatment verification or other necessary information may be required.
If your dentist has recommended dental treatment that is expected to cost more than $500, you must have your dentist
prepare a pre-treatment plan.
There is a time limit for proceedings against Sun Life for payment of a claim. A proceeding must be started within 1
year of Sun Life’s receipt of the proof of claim.


Exclusions and Limitations
No benefit is payable for
•    expenses for which benefits are payable under a Workers' Compensation Act, Workplace Safety and Insurance
     Act or other similar legislation,
•    expenses incurred due to intentionally self-inflicted injuries,
•    expenses incurred due to civil disorder or war, whether or not war was declared,
•    expenses for which benefits are payable under a government plan.
Anaesthesia and laboratory procedure charges must be completed in conjunction with other services and the amount
payable will be limited to the reimbursement percentage of the services they are being performed in conjunction with.
Laboratory charges are also limited to 66 2/3% of the fee for the procedure in the Dental Fee Guide shown on the
Summary of Benefits.


At Termination
If you die, your covered dependant's Dental Benefits will be continued for 3 months without payment of premiums as
long as the Dental provision remains in force. Your dependants must contact your Plan Administrator to arrange the
extension of coverage.




Dental Provision (ar01v010)                                                            R-2
September 1, 2010 (25456)
 S            as01v006

Dental Provision - Preventive Benefit

Eligible Expenses
Eligible expenses mean reasonable and customary charges for the following items of expense -
Procedures
     a. examination and diagnosis:
          •   oral examination,
          •   recall oral examination (once every 6 months for members and covered dependants 19 years of age and
              under and once every 9 months for members and covered dependants over 19 years of age),
          •   special oral examination,
          •   treatment planning,
          •   emergency and unusual services,
          •   consultation,
          •   house call, institutional call and office visit,
     b. tests and laboratory examinations:
          •   biopsy of oral tissue,
          •   pulp vitality tests,
     c. radiographs:
          •   periapical (one complete series every 2 years),
          •   occlusal,
          •   bitewing (once every 6 months for members and covered dependants 19 years of age and under and once
              every 9 months for members and covered dependants over 19 years of age),
          •   extra oral,
          •   sialography,
          •   radiopaque dyes to demonstrate lesions,
          •   panoramic (once every 2 years),
          •   interpretation of radiographs received from another source,
          •   tomography,
     d. preventive services:
          •   dental prophylaxis/polishing (4 times per calendar year),
          •   topical application of fluoride phosphate (once every 6 months for members and covered dependants 19
              years of age and under and once every 9 months for members and covered dependants over 19 years of
              age),
          •   pit and fissure sealant (for children under 19 years of age),
          •   caries control,
          •   interproximal discing,
     e. space maintainers
     f.   restorations:
          •   amalgam,
          •   acrylic or composite resin,
          •   steel crown - primary teeth,
     g. endodontics:
          •   pulpotomy,
          •   root canal therapy,
          •   periapical services,
          •   other endodontic procedures,
          •   emergency procedures,




Dental Provision - Preventive Benefit (as01v006)                                  S-1
September 1, 2010 (25456)
   h. periodontics:
        •   non surgical services,
        •   occlusal equilibration (not exceeding 8 time units every year),
        •   scaling and root planning,
   i.   relining and rebasing of dentures:
        •   repairs to bridges,
   j.   denture repairs
   k. surgical services:
        •   uncomplicated removals,
        •   surgical removals and repositioning,
        •   surgical excision,
        •   surgical incision,
        •   fractures,
        •   lacerations,
        •   frenectomy,
        •   miscellaneous surgical services,
   l.   major surgery:
        •   alveoplasty,
        •   excision of tumor,
        •   dislocations,
   m. appliances to control harmful habits
   n. anaesthesia in connection with oral surgery and drug injections:


Exclusions
No benefit is payable for expenses incurred for the treatment of malocclusion or for orthodontic treatment.




Dental Provision - Preventive Benefit (as01v006)                                   S-2
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Dental Insurance Provision – Orthodontic Services

Eligible Expenses
Eligible expenses mean reasonable and customary charges for the following items of expense incurred by an
insured dependent child for the treatment of malocclusion or for orthodontic treatment -
a. miscellaneous services:
     •   space maintainers
     •   diagnostic cast
     •   observation and adjustment
     •   oral examination
b. active appliances for tooth guidance or uncomplicated tooth movement
c. appliances to control harmful habits:
     •   myofunctional therapy
d. retention appliances:
e. in office laboratory procedures




Dental Insurance Provision – Orthodontic Services (av03v142)                  S-3
September 1, 2010 (25456)

				
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